A  CAJM  article on General Practice (GP)  in Zimbabwe (formerly Rhodesia)The term general practice is familiar to everyone 'in the medical profession who has been brought ' up in the British tradition of medicine. Nevertheless, there are a number of other terms which have been used to cover this branch of medicine. We are familiar with the family doctor, family physician, personal physician and others, but for the sake of definition we are considering in this paper the doctor who makes first contact on a personal basis with a person, be he seeking advice for an ailment from which he is already suffering or, perhaps more important, seeking advice whereby he might prevent an ailment occurring in the future

Fraser, Ross. W.

Central African Journal of Medicine

English

The term general practice is familiar to everyone 'in the medical profession who has been brought ' up in the British tradition of medicine. Nevertheless, there are a number of other terms which have been used to cover this branch of medicine. We are familiar with the family doctor, family physician, personal physician and others, but for the sake of definition we are considering in this paper the doctor who makes first contact on a personal basis with a person, be he seeking advice for an ailment from which he is already suffering or, perhaps more important, seeking advice whereby he might prevent an ailment occurring in the future

Fraser,  Ross. W.

National Research Database of Zimbabwe

Broadening The Horizon: A Glimpse Of General Practice In Rhodesia

IDS OpenDocs

The Central African Journal of Medicine
Editor: \\
MICHAEL GELFAND, C.B.E., M.D., F.R.C.P.’r
Assistant Editor: 
JOSEPH RITCHKEN, M.D.
Volume Eighteen 
JANUARY - DECEMBER 
1972
C//V//__-—
36001836818 UZ L ib r a r y
Salisbury R hodesia
T he C e n t r a l  A f r i c a n
Journal of Medicine
Volume 18 JANUARY, 1972 No. 1
Broadening the Horizon*
A Glimpse of General Practice 
. , in Rhodesia
V /1
1 W. FRASER ROSS,
b.sc., m .b ., CH.B.(St. A nd .), D.p.H.(Lond.)
The term general practice is familiar to everyone 
'in the medical profession who has been brought 
' up in the British tradition of medicine. Neverthe­
less, there are a number of other terms which have 
been used to cover this branch of medicine. We 
are familiar with the family doctor, family iphysi- 
cian, personal physician and others, but for the 
sake of definition we are considering in this paper 
the doctor who makes first contact on a personal 
basis with a person, be he seeking advice for an 
ailment from which he is already suffering or, 
perhaps more important, seeking advice whereby 
he might prevent an ailment occurring in the 
future.
It must be obvious that the scope of general 
practice varies widely from one country to an­
other, and even within a country the variation 
may he considerable. When considering a country 
such as Rhodesia, where there are few towns of
!any considerable size and a population scattered widely throughout an area of 150,000 square 
| miles, it does not take much imagination to see 
i that there will be considerable variation in the 
types of general practice from that found in the 
more densely populated countries of Western 
Europe. The work of the general practitioner in 
Rhodesia varies from the relatively sophisticated 
type of practice found in the large towns such as 
.Salisbury, where the doctor is rendering a per­
sonal care service for two or three thousand 
people, to that of a practitioner in the more re­
mote rural areas where he may be rendering the 
only medical care to 60 to 100,000 people, having 
primary contact with a few but medical responsi­
bility through para-medical personnel for the
many.
An address read at the General Practice Section of the 
1969 South African Medical Congress in Pretoria.
Ross and Rittey (1969), when considering ways 
and means of providing “a glimpse at general 
practice” to undergraduates, considered there 
were seven different types of general practice in 
Rhodesia. These were—
(J) General practice in a large town among a 
sophisticated type of patient, with easy 
availability of hospitalisation, consultant 
services and diagnostic aids such as X-rays 
and laboratory'services.
(2) General practice in a small country town, 
c among sophisticated patients, with a small
hospital, limited X-ray and laboratory ser­
vices and no readily available consultant 
services. V
(3) General practice on a mission station 
among less sophisticated people, with large 
numbers of patients, few ancillary services, 
limited hospitalisation, but fairly easy 
access to a large centre.
(4) General practice similar to (3) above, but 
•in a remote area with difficulty of access, 
sometimes completely cut off in the rainy 
weather.
(5) General practice in a mining community 
with good facilities, both European and 
African patients to be looked after, and 
the challenge of occupational medicine to 
be met.
(6) 'General practice on an agricultural estate, 
with problems not dissimilar to those of 
the mining community, but with medical 
hazards associated with irrigation, e.g., 
bilharziasis and hookworm.
(7) General practice as carried out by a Gov­
ernment medical officer, usually in rural 
Rhodesia, with responsibility for a large 
area, probably a base hospital and several 
rural hospitals and the need to provide 
personal physician care for a few fairly 
demanding Europeans, and community 
care for what may be many thousands of 
African people.
It will be -seen, therefore, that the qualities and 
skills required of the general practitioners in 
these varying practice situations are widely diif-
1
January, 1972. GENERAL PRACTICE IN RHODESIA The Central African 
Journal of Medicine
ferent in some ways and yet very similar in others. 
The more remote the doctor from his colleagues, 
the more resourceful he will have to be and the 
more important will it be to ensure that his .skills 
are kept up to date because of his less informal 
opportunity to have constant contact with col­
leagues. The myth of the clever doctor being 
associated with urban practice and the professional 
dead-beat being rusticated to the rural area must 
be buried forever when the enormity of the task 
and the responsibilities of a rural area are con­
sidered in the hard light of day.
I believe that during the undergraduate training 
an .opportunity must be afforded to the medical 
student to become aware or familiar with the 
world of medical practice beyond the walls of the 
teaching hospital. Although I believe the teaching 
hospital should have no walls, nevertheless we 
seem to have to accept that in the eyes of many 
colleagues it is the be all and end all of medical 
practice. To overcome this, various schemes of 
general practice attachments have been devised in 
different parts of .the world. Some are voluntary 
and arranged by the student in a vacation, while in 
others attachment is compulsory and arranged 
by the faculty. In some the attachment is for 
as little as a week and in others for a longer 
period up to four to six weeks. In some medi­
cal schools a department of general praotice 
has been established in which the student spends 
“formal teaching time”, while in . others no 
effort at all is made to acquaint the student with 
this type of practice. In some parts of the world 
the attachment of a student to a rural health 
service, frequently run by the department of social 
and preventive medicine, is seen as being a type of 
general practice attachment.
At the University of Rhodesia the department 
of social and preventive medioine has undertaken, 
on behalf of the faculty of medicine, the task of 
providing what we call “a glimpse at the practice 
of medicine outwith the teaching hospital.” To 
this end we attach our students for a period of two 
weeks, at the end of the fifth year, to one of the 
seven types of practice listed previously, the 
arrangements being made by the Department.
As the number of students in each year is still 
small, being of the order of 20 to 35, and we have 
only had two years’ experience, it is perhaps too 
early to be able to come to any major conclusions. 
On the other hand, the opportunity of close per­
sonal contact with students allows me to say that 
this has been a most popular scheme and more 
than one student has already taken steps to revisit 
the doctor with whom he spent his attachment: In 
many cases the student has stayed in the home of
his mentor and has thus shared fully in the trials 
and tribulations of the practice. I believe that this 
attachment scheme has certainly given the under­
graduate the opportunity to familiarise himself 
with the problems of general practice and not a 
few have said how much they welcomed this 
chance to broaden their horizons. It must be 
emphasised that this attachment is designed to 
“broaden the horizons” and not to actively recruit 
in any military sense.
It would seem to be a truism to say that any 
medical school .should produce graduates fitted to 
the practice of medicine in the country in which 
it is situated. However, it is now generally agreed 
that at the time of graduation the young graduate 
still has to undergo a period of vocational training 
before he is fitted to take his rightful place in the 
medical community, no matter what his choice of 
career may be. In the light of my earlier descrip­
tion of the varieties of general practice in Rho­
desia, it will be rbadily agreed that the need for 
vocational training in general practice, and more 
particularly for those in the more remote areas, is 
very real. If the school of medicine is to take its 
rightful part in Such training there must be a good 
liaison with and understanding of the needs of the 
practitioners throughout. the length and breadth 
of the country.
Ross (1967), as a result of a study of the regis­
ter of medical practitioners at the end of 1965, I 
was able to establish some idea of the future medi­
cal manpower requirements of Rhodesia. At the 
time of the investigation there were only 504 
registered doctors living in Rhodesia, of whom 
473 were in full- or part-time practice. In this 
survey it was found that 78 per cent, of those 
doctors practising were to be found In six towns, 
leaving 22 per cent, to serve the rest of the coun­
try. It can be appreciated, therefore, that the , 
doctors working in the less urbanised and rural 
areas carry an enormous medical responsibility, , 
bearing in mind that they care for 84 per cent, of 
the population. While in.the six towns referred 
to there are a goodly number of general practi-^ 
tioners of what we might call the conventional 
type, it seems to me that it is those who are caring 
for the 84 per cent, of the population to whom we 
must particularly direct our attention. -
In making this statement I wish to make it clear 
I am in no way derogating the skills of the general 
practitioner in the urban areas, the standard of . 
which, I believe, is above average in Rhodesia, 
but I am merely emphasising the problems which 
fall on those in the more remote areas. By estab­
lishing our medical practitioner attachment 
scheme, this has allowed us to be in close touch 
with a  variety of practitioners in various parts of
2
January, 1972. GENERAL PRACTICE IN RHODESIA T he Central African Journal of Medicine
the country. Furthermore, as an effort is made by 
members of staff of the Department of Social 
Medicine to visit as many of the students as pos­
sible during their attachment, this brings in its 
wake the possibility of the faculty being informed 
of the varying problems of practice' throughout 
the country.
When the survey of Rhodesian doctors was 
carried out it was found that 47 per cent, of the 
registered medical practitioners were over 45 years 
of age. When it is borne in mind that many of 
the younger doctors were those who were work­
ing in the larger hospitals as interns and registrars, 
it will be seen that there is cause for concern at 
the age structure of those who are rendering 
general practitioner care, either in urban or rural 
areas.
When any new faculty of medicine comes into 
being the question must be asked about the pro­
vision of postgraduate facilities. It might well be 
argued that teaching should start at postgraduate 
level and then later venture into undergraduate 
training. It may be easier in the first instance in a 
small community to attempt to refresh those who 
have already been taught rather than to attempt 
the production of a whole graduate from scratch. 
Fortunately in Rhodesia, for a number of years 
before the establishment of the faculty of medi­
cine in 1962, efforts had been made to cater in a 
small way for the needs of the profession by the 
establishment of libraries, clinical meetings, teach­
ing rounds and in other ways. These were suppor­
ted by general and specialist practitioners alike and 
it might be said that these were the beginning of 
postgraduate facilities.
In view of the fact that the greatest need in 
Rhodesia is for well-trained general practitioners, 
it seems obvious to me that this is one area in par­
ticular where the young faculty of medicine should 
spread its wings in the postgraduate field. In 1966 
the faculty established a Postgraduate Medical 
Education Committee, and under its auspices a 
number of one-day symposia have been arranged. 
These have catered primarily for the general prac­
titioner in rural practice, but nursing staff have 
also been encouraged to come.
Sight must not be lost of the value of bringing 
together doctors who in their daily work may not 
have much opportunity of professional contact. 
When we remember the distances which many of 
'these men (and women) had to travel to attend 
|these one-day courses and the enthusiasm with 
which they were received, the organisers have 
. been encouraged to extend their interests to the 
possibility of arranging clinical meetings and dis­
cussions in .smaller centres even if only a few 
people could attend.
It is hoped that suitable training courses can be 
established in the teaching hospital in association 
with the Ministry of Health. Following the com­
pulsory pre-registration year in medicine and sur­
gery, it is the hope of the faculty of medicine that 
for those doctors wishing to take up general prac­
tice a further two-year programme of training may 
be instituted. We would envisage a further year 
in the teaohing hospital or similar major hospital, 
where six months would be spent in obstetrics and 
six months covering subjects such _as dermatology, 
ear, nose and throat diseases and ophthalmology, 
with opportunity at this time to obtain further 
experience in anaesthesiology, community medi­
cine and the like. The second year would be spent 
obtaining a wider experience in a smaller general 
hospital working with an experienced general prac­
titioner, where opportunity would be available to 
broaden the experience already gained and also 
to exercise increasingly the;'/individual responsi­
bility which is so essential in general practice.
1 i! iAlthough many would wish to make a career 
in private practice as a family physician, it is con­
sidered that the experience which would be gained 
in a training programme as outlined above would 
be invaluable in providing a 'sound basis for any 
of the types of general practice which were de­
scribed previously. The essence of being a good 
general practitioner is to be a sound doctor, and 
this can be best achieved by an environment in 
which the young doctor can have the chance to 
develop and broaden his skills in an atmosphere 
of medicine well practised and adequately super­
vised. There must, however, be scope for the de­
velopment of personal initiative.
In a country like Rhodesia I believe it is essen­
tial to develop ways and means of encouraging 
doctors to keep in contact with facilities which 
will allow them not only to have the opportunity 
to acquire new knowledge, but to share with each 
other personal experiences. For this reason I have 
no doubt that the day of single-handed practice is 
gone. No longer can we expect a doctor to bury 
himself in a rural area providing a total health 
service on his own. In future, group practices must 
be developed where particular skills may be en­
couraged within the general background and 
where opportunity exists for a regular division of 
work and leisure.
Summary
The scope of general practice varies from one 
country to another, and even within the same 
country the types of general practice may vary. 
The various patterns of general practice in Rho-
3
Idesia are considered and the qualities and skills 
required to undertake the differing types of prac­
tice are described.
Methods whereby undergraduates can be given 
some insight into the opportunities of general 
practice are discussed and a programme to demon­
strate the professional requirements of the types 
of general practice met with in Rhodesia is pre­
sented.
It is important for a school of medicine con­
stantly to keep under review the structure of 
general practice in the country it serves, not only 
in relation to the teaching of the necessary skills, 
but also in relation to the present and future medi­
cal manpower requirements. Efforts to make such 
a survey of medical needs of this nature in Rho­
desia are presented.
The place of a young faculty of medicine in 
providing facilities for training in general practice 
is reviewed and the point is made that this may 
be the most important postgraduate service which 
can be provided in the early years of the faculty 
in a developing country. Opportunity is also taken 
to discuss ways and means of arranging facilities 
to encourage practitioners to remain in general 
practice.
REFERENCES
Ross, W. F. (1967). C. Afr. J. Med., 13, 273.
Rittey, D. A. W. & Ross, W. F. (1969). Brit. J. med.
Educ., 3, 94.
Vol. 18. No. 1. January, 1972.
This work is licensed under a 
Creative Commons
Attribution -  Noncommercial - NoDerivs 3.0 License.
To view a copy of the license please see: 
http://creativecommons.org/licenses/by-nc-nd/3.0/
This is a download from the BLDS Digital Library on OpenDocs
http://opendocs.ids.ac.uk/opendocs/
Institute of 
Development Studies


https://opendocs.ids.ac.uk/opendocs/bitstream/20.500.12413/5129/1/Fraser%20Ross%2c%20%20W.%20%20CAJM%20%20vol.%2018%2c%20no.1..pdf

Broadening The Horizon: A Glimpse Of General Practice In Rhodesia

Abstract

Similar works

Full text

Available Versions

National Research Database of Zimbabwe

IDS OpenDocs